Postoperative management of differentiated thyroid cancer Journal Article
| Authors: | Cohen, E. G.; Tuttle, R. M.; Kraus, D. H. |
| Article Title: | Postoperative management of differentiated thyroid cancer |
| Abstract: | The large numbers of studies on the postoperative management of differentiated thyroid carcinoma allows us to use adjuvant treatment and follow-up studies more selectively based on patient risk for recurrence and mortality. Recurrent differentiated thyroid carcinoma is more easily and more effectively treated with early diagnosis. With this in mind, patients who are at high risk for life-threatening recurrent disease should be treated aggressively and followed up expectantly. In these patients, adjuvant treatment with 131I ablation and thyroid hormone suppression is appropriate. External irradiation may be considered, especially for patients with postoperative residual disease. Close follow-up with stimulated thyroglobulin and 131I whole body scans should be performed to facilitate early detection of recurrent disease. Low-risk patients may be effectively treated with more conservative management. 131I ablation has not resulted in improved survival in these patients. Follow-up with serum thyroglobulin after initial negative 131I whole body scan may be appropriate in these patients. Management of patients at intermediate risk remains controversial. Recombinant human thyrotropin allows us to obtain stimulated serum thyroglobulin and promises the ability to perform 131I ablation and whole body scan without the need for thyroid hormone withdrawal. Functional radionuclide imaging, such as FDG PET, now allows us to localize recurrent disease in patients with elevated serum thyroglobulin but negative 131I scan. |
| Keywords: | cancer survival; treatment outcome; survival analysis; cancer surgery; review; cancer recurrence; postoperative period; cancer risk; side effect; cancer adjuvant therapy; cancer radiotherapy; postoperative care; radiation dose; combined modality therapy; nuclear magnetic resonance imaging; positron emission tomography; follow up; lymph node metastasis; reverse transcription polymerase chain reaction; neoplasm recurrence, local; adenoma, oxyphilic; cancer mortality; lung metastasis; iodine 131; echography; thyroidectomy; thyroid cancer; thyroid neoplasms; cancer epidemiology; high risk population; levothyroxine; thyroglobulin; cervical lymph node; vocal cord paralysis; dose calculation; adenocarcinoma, follicular; adenocarcinoma, papillary; recombinant thyrotropin; fluorodeoxyglucose; hypoparathyroidism; thyrotoxicosis; humans; human |
| Journal Title: | Otolaryngologic Clinics of North America |
| Volume: | 36 |
| Issue: | 1 |
| ISSN: | 0030-6665 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2003-02-01 |
| Start Page: | 129 |
| End Page: | 157 |
| Language: | English |
| DOI: | 10.1016/s0030-6665(02)00137-8 |
| PUBMED: | 12803014 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 25 September 2014 -- Source: Scopus |
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